1097 EFFICACY OF COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA IN PATIENTS WITH INSOMNIA COMORBID WITH MAJOR DEPRESSION.

Abstract

Introduction: Insomnia is a highly frequent comorbidity of Major Depressive Disorder (MDD). Although benzodiazepine receptor agonists are usually used, there are concerns about their long-term safety. On the other hand, Cognitive Behavioral Therapy for Insomnia (CBTI) has demonstrated its efficacy on primary insomnia, but evidence is scarce in insomnia comorbid with MDD. In addition, these few studies do not reflect common clinical practices, where combination of drug treatments is frequently used. On this basis, the aim of this study was to evaluate the efficacy of adding CBT-I in patients with insomnia and MDD when receiving pharmacological Treatment as Usual (TAU). Methods: Outpatients with MDD and insomnia who were receiving TAU were recruited. They were randomly assigned to receive CBT-I (four weekly sessions including sleep education, sleep hygiene, stimulus control, sleep restriction and cognitive therapy) or being put on a waiting list (WL) where subjects only received sleep hygiene education. A follow-up evaluation with Insomnia Severity Index and Hamilton Depression Rating Scale was carried out at the end of the 4-week CBT-I program and one month after the basal evaluation in the WL group. Results: Twenty and 15 patients were assigned to CBT-I and WL groups, respectively. There were no significant differences in demographic, clinical, and pharmacological treatment between groups. In comparison to the control group (pre 16.2 ± 4.8, post 13.8 ± 7.8), adding CBT-I to TAU (pre 18.2 ± 3.8, post 10.6 ± 4.4) resulted in a significant reduction of insomnia symptoms (F=6.8, p=.003). No significant differences were found in depression scores (F=1.7, p=.19) between CBT-I group (pre 20.0 ± 6.4 post 9.1 ± 6.1) and the WL group (pre 23.6 ± 5.8 post 16.1 ± 9.1). Conclusion: Results of this study suggest that adding CBT-I to TAU produces significant improvement of insomnia in adult outpatients with MDD under usual pharmacological treatment.